外周血癌胚抗原水平与晚期非小细胞肺癌患者EGFR-TKI疗效的相关性

Value of carcinoembryonic antigen levels in predicting the efficacy of EGFR-TKI in advanced nonsmall cell lung cancer harboring EGFR mutations

目的 探讨外周血癌胚抗原（CEA）水平与晚期非小细胞肺癌（NSCLC）患者表皮生长因子受体-酪氨酸激酶抑制剂（EGFR-TKI）疗效的相关性.方法 回顾性分析2010年9月至2013年12月上海交通大学附属胸科医院呼吸内科接受EGFR-TKI治疗的EGFR突变阳性的170例晚期NSCLC患者的临床资料.分析治疗前不同基线外周血CEA水平与EGFR-TKI疗效的相关性.本研究中CEA水平正常值为＜5μg/L.结果 患者总体客观缓解率为37.6％,疾病控制率为90.0％.CEA升高者接受EGFR-TKI治疗具有更好地疾病控制率（94.3％比80.4％,P=0.022）.影响无疾病进展时间（PFS）的单因素分析显示在一定范围内随着基线CEA水平的升高,风险比（HR）值逐渐增大;CEA＞ 20 μg/L者与CEA≤20 μg/L者PFS差异有统计学意义（HR=1.444,95％ CI：1.036 ～2.014,P=0.030）.细胞角蛋白19片段（CYFRA21-1）水平升高者较正常者PFS差异无统计学意义（HR=1.167,95％ CI：0.840～1.622,P=0.357）.EGFR-TKI治疗后1个月内CEA水平的变化类型与疗效有显著相关性（HR =7.344,95％ CI：2.903～ 18.578,P＜0.001）.结论 外周血CEA水平与晚期NSCLC患者EGFR-TKI疗效密切相关,基线CEA高者更能在EGFR-TKI治疗中获益.

Objective To explore the relevance of carcinoembryonic antigen （CEA） level and efficacy of epidermal growth factor receptor-tyrosine kinase inhibitor （EGFR-TKI） in advanced non-small cell lung cancer （NSCLC） harboring EGFR mutations.Methods Between September 2010 and December 2013,170 NSCLC patients harboring EGFR mutations receiving EGFR-TKI treatment at pulmonary medicine department of Shanghai Chest hospital were retrospectively screened.They were screened for clinical characteristics,efficacy of EGFR-TKI,and tumor markers （CEA/cytokerantin-19-fragment CYFRA21-1） at an initial diagnosis.The cutoff value for CEA was 5 μg/L.Results The overall objective response rate （ORR） was 37.6％ and disease control rate （DCR） 90.0％.Those with high CEA levels （＞5 μg/L） had better DCR （94.3％ vs 80.4％,P =0.022）.Univariate analysis showed that patients with high CEA levels （≥20 μg/L） had significantly longer progression-free survival （PFS） than those with low CEA level （HR =1.444,95％ CI：1.036-2.014,P =0.030）.HR value increased with rising CEA levels.No significant difference in PFS existed between high-CYFRA21-1 and normal-CYFRA21-1 groups （HR =1.167,95％ CI：0.840-1.622,P =0.357）.Close follow-ups were conducted for 51 patients on EGFR-TKI treatment.And their CEA levels was tested within one month after treatment.The patients in descending type group had longer PFS than other two types （HR=7.344,95％CI：2.903-18.578,P＜0.001）.Conclusions CEA level has a close correlation with the efficacy of EGFR-TKI treatment.And a high CEA level may be a predictive marker for better response and longer PFS in advanced NSCLC.